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Service Code HCPCS C1730
Hospital Charge Code 4139317
Hospital Revenue Code 481
Min. Negotiated Rate $747.25
Max. Negotiated Rate $1,403.00
Rate for Payer: Aetna Commercial $1,372.50
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,311.50
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $808.25
Rate for Payer: Cash Price $457.50
Rate for Payer: Cigna Commercial $1,403.00
Rate for Payer: Health EOS Commercial $1,357.25
Rate for Payer: HFN Commercial $1,403.00
Rate for Payer: Multiplan Commercial $1,220.00
Rate for Payer: NAPHCARE Commercial $915.00
Rate for Payer: Preferred Network Access Commercial $1,403.00
Rate for Payer: Quartz Beloit One Network $747.25
Rate for Payer: Quartz Commercial $915.00
Rate for Payer: WEA Trust Commercial $838.75
Rate for Payer: WPS Commercial $1,129.57
Service Code CPT 93620
Hospital Charge Code 3052508
Hospital Revenue Code 481
Min. Negotiated Rate $7,381.60
Max. Negotiated Rate $29,526.40
Rate for Payer: Aetna Commercial $16,214.40
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $15,493.76
Rate for Payer: Aetna Managed Medicare $7,381.60
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $29,139.00
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $26,420.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $25,100.00
Rate for Payer: Anthem Medicare Advantage $7,381.60
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $9,548.48
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $7,381.60
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $7,381.60
Rate for Payer: Cash Price $5,404.80
Rate for Payer: Cash Price $5,404.80
Rate for Payer: Cash Price $5,404.80
Rate for Payer: Cigna Commercial $16,574.72
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial $7,381.60
Rate for Payer: Dean Health DHI/DHP/ASO $10,081.75
Rate for Payer: Dean Health Medicare Advantage/Medicare Select $7,381.60
Rate for Payer: Health EOS Commercial $16,034.24
Rate for Payer: HFN Commercial $16,574.72
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $27,459.55
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $7,381.60
Rate for Payer: Independent Care Health Plan Medicare $7,381.60
Rate for Payer: Managed Health Services Medicare Advantage $7,381.60
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace $7,381.60
Rate for Payer: Multiplan Commercial $14,412.80
Rate for Payer: NAPHCARE Commercial $11,072.40
Rate for Payer: Preferred Network Access Commercial $16,574.72
Rate for Payer: Quartz Beloit One Network $8,827.84
Rate for Payer: Quartz Commercial $11,710.40
Rate for Payer: Quartz Medicare Advantage $7,381.60
Rate for Payer: The Alliance Commercial $29,526.40
Rate for Payer: United Healthcare Medicare Advantage $7,381.60
Rate for Payer: WEA Trust Commercial $9,908.80
Rate for Payer: Wellcare Medicare $7,381.60
Rate for Payer: WPS Commercial $13,344.45
Service Code CPT 93620
Hospital Charge Code 3052508
Hospital Revenue Code 481
Min. Negotiated Rate $8,827.84
Max. Negotiated Rate $16,574.72
Rate for Payer: Aetna Commercial $16,214.40
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $15,493.76
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $9,548.48
Rate for Payer: Cash Price $5,404.80
Rate for Payer: Cigna Commercial $16,574.72
Rate for Payer: Health EOS Commercial $16,034.24
Rate for Payer: HFN Commercial $16,574.72
Rate for Payer: Multiplan Commercial $14,412.80
Rate for Payer: NAPHCARE Commercial $10,809.60
Rate for Payer: Preferred Network Access Commercial $16,574.72
Rate for Payer: Quartz Beloit One Network $8,827.84
Rate for Payer: Quartz Commercial $10,809.60
Rate for Payer: WEA Trust Commercial $9,908.80
Rate for Payer: WPS Commercial $13,344.45
Service Code CPT 93619
Hospital Charge Code 3052507
Hospital Revenue Code 481
Min. Negotiated Rate $7,381.60
Max. Negotiated Rate $29,526.40
Rate for Payer: Aetna Commercial $16,214.40
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $15,493.76
Rate for Payer: Aetna Managed Medicare $7,381.60
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $29,139.00
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $26,420.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $25,100.00
Rate for Payer: Anthem Medicare Advantage $7,381.60
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $9,548.48
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $7,381.60
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $7,381.60
Rate for Payer: Cash Price $5,404.80
Rate for Payer: Cash Price $5,404.80
Rate for Payer: Cash Price $5,404.80
Rate for Payer: Cigna Commercial $16,574.72
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial $7,381.60
Rate for Payer: Dean Health DHI/DHP/ASO $10,081.75
Rate for Payer: Dean Health Medicare Advantage/Medicare Select $7,381.60
Rate for Payer: Health EOS Commercial $16,034.24
Rate for Payer: HFN Commercial $16,574.72
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $27,459.55
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $7,381.60
Rate for Payer: Independent Care Health Plan Medicare $7,381.60
Rate for Payer: Managed Health Services Medicare Advantage $7,381.60
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace $7,381.60
Rate for Payer: Multiplan Commercial $14,412.80
Rate for Payer: NAPHCARE Commercial $11,072.40
Rate for Payer: Preferred Network Access Commercial $16,574.72
Rate for Payer: Quartz Beloit One Network $8,827.84
Rate for Payer: Quartz Commercial $11,710.40
Rate for Payer: Quartz Medicare Advantage $7,381.60
Rate for Payer: The Alliance Commercial $29,526.40
Rate for Payer: United Healthcare Medicare Advantage $7,381.60
Rate for Payer: WEA Trust Commercial $9,908.80
Rate for Payer: Wellcare Medicare $7,381.60
Rate for Payer: WPS Commercial $13,344.45
Service Code CPT 93619
Hospital Charge Code 3052507
Hospital Revenue Code 481
Min. Negotiated Rate $8,827.84
Max. Negotiated Rate $16,574.72
Rate for Payer: Aetna Commercial $16,214.40
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $15,493.76
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $9,548.48
Rate for Payer: Cash Price $5,404.80
Rate for Payer: Cigna Commercial $16,574.72
Rate for Payer: Health EOS Commercial $16,034.24
Rate for Payer: HFN Commercial $16,574.72
Rate for Payer: Multiplan Commercial $14,412.80
Rate for Payer: NAPHCARE Commercial $10,809.60
Rate for Payer: Preferred Network Access Commercial $16,574.72
Rate for Payer: Quartz Beloit One Network $8,827.84
Rate for Payer: Quartz Commercial $10,809.60
Rate for Payer: WEA Trust Commercial $9,908.80
Rate for Payer: WPS Commercial $13,344.45
Hospital Charge Code 3052574
Hospital Revenue Code 480
Min. Negotiated Rate $265.58
Max. Negotiated Rate $498.64
Rate for Payer: Aetna Commercial $487.80
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $466.12
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $287.26
Rate for Payer: Cash Price $162.60
Rate for Payer: Cigna Commercial $498.64
Rate for Payer: Health EOS Commercial $482.38
Rate for Payer: HFN Commercial $498.64
Rate for Payer: Multiplan Commercial $433.60
Rate for Payer: NAPHCARE Commercial $325.20
Rate for Payer: Preferred Network Access Commercial $498.64
Rate for Payer: Quartz Beloit One Network $265.58
Rate for Payer: Quartz Commercial $325.20
Rate for Payer: WEA Trust Commercial $298.10
Rate for Payer: WPS Commercial $401.46
Hospital Charge Code 3052574
Hospital Revenue Code 480
Min. Negotiated Rate $151.76
Max. Negotiated Rate $2,168.00
Rate for Payer: Aetna Commercial $487.80
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $466.12
Rate for Payer: Aetna Managed Medicare $151.76
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $352.30
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $271.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $260.16
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $287.26
Rate for Payer: Cash Price $162.60
Rate for Payer: Cigna Commercial $498.64
Rate for Payer: Dean Health DHI/DHP/ASO $303.30
Rate for Payer: Health EOS Commercial $482.38
Rate for Payer: HFN Commercial $498.64
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $406.50
Rate for Payer: Multiplan Commercial $433.60
Rate for Payer: NAPHCARE Commercial $325.20
Rate for Payer: Preferred Network Access Commercial $498.64
Rate for Payer: Quartz Beloit One Network $265.58
Rate for Payer: Quartz Commercial $352.30
Rate for Payer: Quartz Medicare Advantage $325.20
Rate for Payer: The Alliance Commercial $2,168.00
Rate for Payer: United Healthcare PPO $406.50
Rate for Payer: WEA Trust Commercial $298.10
Rate for Payer: WPS Commercial $401.46
Service Code CPT 93624
Hospital Charge Code 3052511
Hospital Revenue Code 481
Min. Negotiated Rate $1,063.20
Max. Negotiated Rate $29,526.40
Rate for Payer: Aetna Commercial $1,993.50
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,904.90
Rate for Payer: Aetna Managed Medicare $7,381.60
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $1,439.75
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $1,107.50
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $1,063.20
Rate for Payer: Anthem Medicare Advantage $7,381.60
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $1,173.95
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $7,381.60
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $7,381.60
Rate for Payer: Cash Price $664.50
Rate for Payer: Cash Price $664.50
Rate for Payer: Cigna Commercial $2,037.80
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial $7,381.60
Rate for Payer: Dean Health DHI/DHP/ASO $1,239.51
Rate for Payer: Dean Health Medicare Advantage/Medicare Select $7,381.60
Rate for Payer: Health EOS Commercial $1,971.35
Rate for Payer: HFN Commercial $2,037.80
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $27,459.55
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $7,381.60
Rate for Payer: Independent Care Health Plan Medicare $7,381.60
Rate for Payer: Managed Health Services Medicare Advantage $7,381.60
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace $7,381.60
Rate for Payer: Multiplan Commercial $1,772.00
Rate for Payer: NAPHCARE Commercial $11,072.40
Rate for Payer: Preferred Network Access Commercial $2,037.80
Rate for Payer: Quartz Beloit One Network $1,085.35
Rate for Payer: Quartz Commercial $1,439.75
Rate for Payer: Quartz Medicare Advantage $7,381.60
Rate for Payer: The Alliance Commercial $29,526.40
Rate for Payer: United Healthcare Medicare Advantage $7,381.60
Rate for Payer: WEA Trust Commercial $1,218.25
Rate for Payer: Wellcare Medicare $7,381.60
Rate for Payer: WPS Commercial $1,640.65
Service Code CPT 93624
Hospital Charge Code 3052511
Hospital Revenue Code 481
Min. Negotiated Rate $1,085.35
Max. Negotiated Rate $2,037.80
Rate for Payer: Aetna Commercial $1,993.50
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,904.90
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $1,173.95
Rate for Payer: Cash Price $664.50
Rate for Payer: Cigna Commercial $2,037.80
Rate for Payer: Health EOS Commercial $1,971.35
Rate for Payer: HFN Commercial $2,037.80
Rate for Payer: Multiplan Commercial $1,772.00
Rate for Payer: NAPHCARE Commercial $1,329.00
Rate for Payer: Preferred Network Access Commercial $2,037.80
Rate for Payer: Quartz Beloit One Network $1,085.35
Rate for Payer: Quartz Commercial $1,329.00
Rate for Payer: WEA Trust Commercial $1,218.25
Rate for Payer: WPS Commercial $1,640.65
Service Code CPT 93641
Hospital Charge Code 5551964
Hospital Revenue Code 510
Min. Negotiated Rate $582.54
Max. Negotiated Rate $3,255.65
Rate for Payer: Aetna Commercial $3,255.65
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $2,947.22
Rate for Payer: Cash Price $1,028.10
Rate for Payer: Cash Price $1,028.10
Rate for Payer: Cigna Commercial $3,255.65
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $582.54
Rate for Payer: Dean Health DHI/DHP/ASO $2,056.20
Rate for Payer: Health EOS Commercial $3,118.57
Rate for Payer: HFN Commercial $3,255.65
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $2,038.05
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $2,038.05
Rate for Payer: Multiplan Commercial $2,741.60
Rate for Payer: Preferred Network Access Commercial $3,255.65
Rate for Payer: Quartz Beloit One Network $1,507.88
Rate for Payer: Quartz Commercial $1,953.39
Rate for Payer: The Alliance Commercial $1,713.50
Rate for Payer: United Healthcare Medicaid $582.54
Rate for Payer: WEA Trust Commercial $1,884.85
Rate for Payer: WPS Commercial $2,538.38
Service Code CPT 93641 26
Hospital Charge Code 5551965
Hospital Revenue Code 510
Min. Negotiated Rate $1,011.24
Max. Negotiated Rate $3,255.65
Rate for Payer: Aetna Commercial $3,255.65
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $2,947.22
Rate for Payer: Cash Price $1,028.10
Rate for Payer: Cash Price $1,028.10
Rate for Payer: Cigna Commercial $3,255.65
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $1,713.50
Rate for Payer: Dean Health DHI/DHP/ASO $2,056.20
Rate for Payer: Health EOS Commercial $3,118.57
Rate for Payer: HFN Commercial $3,255.65
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $1,011.24
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $1,011.24
Rate for Payer: Multiplan Commercial $2,741.60
Rate for Payer: Preferred Network Access Commercial $3,255.65
Rate for Payer: Quartz Beloit One Network $1,507.88
Rate for Payer: Quartz Commercial $1,953.39
Rate for Payer: The Alliance Commercial $1,713.50
Rate for Payer: WEA Trust Commercial $1,884.85
Rate for Payer: WPS Commercial $2,538.38
Service Code CPT 93640
Hospital Charge Code 3052512
Hospital Revenue Code 481
Min. Negotiated Rate $2,251.20
Max. Negotiated Rate $32,160.00
Rate for Payer: Aetna Commercial $7,236.00
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $6,914.40
Rate for Payer: Aetna Managed Medicare $2,251.20
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $5,226.00
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $4,020.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $3,859.20
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $4,261.20
Rate for Payer: Cash Price $2,412.00
Rate for Payer: Cigna Commercial $7,396.80
Rate for Payer: Dean Health DHI/DHP/ASO $4,499.18
Rate for Payer: Health EOS Commercial $7,155.60
Rate for Payer: HFN Commercial $7,396.80
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $6,030.00
Rate for Payer: Multiplan Commercial $6,432.00
Rate for Payer: NAPHCARE Commercial $4,824.00
Rate for Payer: Preferred Network Access Commercial $7,396.80
Rate for Payer: Quartz Beloit One Network $3,939.60
Rate for Payer: Quartz Commercial $5,226.00
Rate for Payer: Quartz Medicare Advantage $4,824.00
Rate for Payer: The Alliance Commercial $32,160.00
Rate for Payer: WEA Trust Commercial $4,422.00
Rate for Payer: WPS Commercial $5,955.23
Service Code CPT 93640
Hospital Charge Code 3052512
Hospital Revenue Code 481
Min. Negotiated Rate $3,939.60
Max. Negotiated Rate $7,396.80
Rate for Payer: Aetna Commercial $7,236.00
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $6,914.40
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $4,261.20
Rate for Payer: Cash Price $2,412.00
Rate for Payer: Cigna Commercial $7,396.80
Rate for Payer: Health EOS Commercial $7,155.60
Rate for Payer: HFN Commercial $7,396.80
Rate for Payer: Multiplan Commercial $6,432.00
Rate for Payer: NAPHCARE Commercial $4,824.00
Rate for Payer: Preferred Network Access Commercial $7,396.80
Rate for Payer: Quartz Beloit One Network $3,939.60
Rate for Payer: Quartz Commercial $4,824.00
Rate for Payer: WEA Trust Commercial $4,422.00
Rate for Payer: WPS Commercial $5,955.23
Service Code CPT 93641
Hospital Charge Code 3052513
Hospital Revenue Code 481
Min. Negotiated Rate $2,276.68
Max. Negotiated Rate $32,524.00
Rate for Payer: Aetna Commercial $7,317.90
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $6,992.66
Rate for Payer: Aetna Managed Medicare $2,276.68
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $5,285.15
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $4,065.50
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $3,902.88
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $4,309.43
Rate for Payer: Cash Price $2,439.30
Rate for Payer: Cigna Commercial $7,480.52
Rate for Payer: Dean Health DHI/DHP/ASO $4,550.11
Rate for Payer: Health EOS Commercial $7,236.59
Rate for Payer: HFN Commercial $7,480.52
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $6,098.25
Rate for Payer: Multiplan Commercial $6,504.80
Rate for Payer: NAPHCARE Commercial $4,878.60
Rate for Payer: Preferred Network Access Commercial $7,480.52
Rate for Payer: Quartz Beloit One Network $3,984.19
Rate for Payer: Quartz Commercial $5,285.15
Rate for Payer: Quartz Medicare Advantage $4,878.60
Rate for Payer: The Alliance Commercial $32,524.00
Rate for Payer: WEA Trust Commercial $4,472.05
Rate for Payer: WPS Commercial $6,022.63
Service Code CPT 93641
Hospital Charge Code 3052513
Hospital Revenue Code 481
Min. Negotiated Rate $3,984.19
Max. Negotiated Rate $7,480.52
Rate for Payer: Aetna Commercial $7,317.90
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $6,992.66
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $4,309.43
Rate for Payer: Cash Price $2,439.30
Rate for Payer: Cigna Commercial $7,480.52
Rate for Payer: Health EOS Commercial $7,236.59
Rate for Payer: HFN Commercial $7,480.52
Rate for Payer: Multiplan Commercial $6,504.80
Rate for Payer: NAPHCARE Commercial $4,878.60
Rate for Payer: Preferred Network Access Commercial $7,480.52
Rate for Payer: Quartz Beloit One Network $3,984.19
Rate for Payer: Quartz Commercial $4,878.60
Rate for Payer: WEA Trust Commercial $4,472.05
Rate for Payer: WPS Commercial $6,022.63
Service Code CPT 93642
Hospital Charge Code 3052514
Hospital Revenue Code 481
Min. Negotiated Rate $4,086.60
Max. Negotiated Rate $7,672.80
Rate for Payer: Aetna Commercial $7,506.00
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $7,172.40
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $4,420.20
Rate for Payer: Cash Price $2,502.00
Rate for Payer: Cigna Commercial $7,672.80
Rate for Payer: Health EOS Commercial $7,422.60
Rate for Payer: HFN Commercial $7,672.80
Rate for Payer: Multiplan Commercial $6,672.00
Rate for Payer: NAPHCARE Commercial $5,004.00
Rate for Payer: Preferred Network Access Commercial $7,672.80
Rate for Payer: Quartz Beloit One Network $4,086.60
Rate for Payer: Quartz Commercial $5,004.00
Rate for Payer: WEA Trust Commercial $4,587.00
Rate for Payer: WPS Commercial $6,177.44
Service Code CPT 93642
Hospital Charge Code 3052514
Hospital Revenue Code 481
Min. Negotiated Rate $1,176.34
Max. Negotiated Rate $7,672.80
Rate for Payer: Aetna Commercial $7,506.00
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $7,172.40
Rate for Payer: Aetna Managed Medicare $1,176.34
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $5,421.00
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $4,170.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $4,003.20
Rate for Payer: Anthem Medicare Advantage $1,176.34
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $4,420.20
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $1,176.34
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $1,176.34
Rate for Payer: Cash Price $2,502.00
Rate for Payer: Cash Price $2,502.00
Rate for Payer: Cigna Commercial $7,672.80
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial $1,176.34
Rate for Payer: Dean Health DHI/DHP/ASO $4,667.06
Rate for Payer: Dean Health Medicare Advantage/Medicare Select $1,176.34
Rate for Payer: Health EOS Commercial $7,422.60
Rate for Payer: HFN Commercial $7,672.80
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $4,375.98
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $1,176.34
Rate for Payer: Independent Care Health Plan Medicare $1,176.34
Rate for Payer: Managed Health Services Medicare Advantage $1,176.34
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace $1,176.34
Rate for Payer: Multiplan Commercial $6,672.00
Rate for Payer: NAPHCARE Commercial $1,764.51
Rate for Payer: Preferred Network Access Commercial $7,672.80
Rate for Payer: Quartz Beloit One Network $4,086.60
Rate for Payer: Quartz Commercial $5,421.00
Rate for Payer: Quartz Medicare Advantage $1,176.34
Rate for Payer: The Alliance Commercial $4,705.36
Rate for Payer: United Healthcare Medicare Advantage $1,176.34
Rate for Payer: WEA Trust Commercial $4,587.00
Rate for Payer: Wellcare Medicare $1,176.34
Rate for Payer: WPS Commercial $6,177.44
Hospital Charge Code 4494582
Hospital Revenue Code 360
Min. Negotiated Rate $2,406.88
Max. Negotiated Rate $4,519.04
Rate for Payer: Aetna Commercial $4,420.80
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $4,224.32
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $2,603.36
Rate for Payer: Cash Price $1,473.60
Rate for Payer: Cigna Commercial $4,519.04
Rate for Payer: Health EOS Commercial $4,371.68
Rate for Payer: HFN Commercial $4,519.04
Rate for Payer: Multiplan Commercial $3,929.60
Rate for Payer: NAPHCARE Commercial $2,947.20
Rate for Payer: Preferred Network Access Commercial $4,519.04
Rate for Payer: Quartz Beloit One Network $2,406.88
Rate for Payer: Quartz Commercial $2,947.20
Rate for Payer: WEA Trust Commercial $2,701.60
Rate for Payer: WPS Commercial $3,638.32
Hospital Charge Code 4494582
Hospital Revenue Code 360
Min. Negotiated Rate $1,375.36
Max. Negotiated Rate $19,648.00
Rate for Payer: Aetna Commercial $4,420.80
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $4,224.32
Rate for Payer: Aetna Managed Medicare $1,375.36
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $3,192.80
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $2,456.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $2,357.76
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $2,603.36
Rate for Payer: Cash Price $1,473.60
Rate for Payer: Cigna Commercial $4,519.04
Rate for Payer: Dean Health DHI/DHP/ASO $2,748.76
Rate for Payer: Health EOS Commercial $4,371.68
Rate for Payer: HFN Commercial $4,519.04
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $3,684.00
Rate for Payer: Multiplan Commercial $3,929.60
Rate for Payer: NAPHCARE Commercial $2,947.20
Rate for Payer: Preferred Network Access Commercial $4,519.04
Rate for Payer: Quartz Beloit One Network $2,406.88
Rate for Payer: Quartz Commercial $3,192.80
Rate for Payer: Quartz Medicare Advantage $2,947.20
Rate for Payer: The Alliance Commercial $19,648.00
Rate for Payer: WEA Trust Commercial $2,701.60
Rate for Payer: WPS Commercial $3,638.32
Service Code CPT 81235
Hospital Charge Code 5276620
Hospital Revenue Code 300
Min. Negotiated Rate $264.01
Max. Negotiated Rate $1,741.56
Rate for Payer: Aetna Commercial $1,703.70
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,627.98
Rate for Payer: Aetna Managed Medicare $324.58
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $1,217.18
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $568.02
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $538.80
Rate for Payer: Anthem Medicaid $264.01
Rate for Payer: Anthem Medicare Advantage $324.58
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $1,003.29
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO $324.58
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO $324.58
Rate for Payer: Cash Price $567.90
Rate for Payer: Cash Price $567.90
Rate for Payer: Cigna Commercial $1,741.56
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial $324.58
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $264.01
Rate for Payer: Dean Health DHI/DHP/ASO $1,059.32
Rate for Payer: Dean Health Medicaid $264.01
Rate for Payer: Dean Health Medicare Advantage/Medicare Select $324.58
Rate for Payer: Health EOS Commercial $1,684.77
Rate for Payer: HFN Commercial $1,741.56
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $1,207.44
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $324.58
Rate for Payer: Independent Care Health Plan Medicaid $264.01
Rate for Payer: Independent Care Health Plan Medicare $324.58
Rate for Payer: Managed Health Services Medicaid $274.57
Rate for Payer: Managed Health Services Medicare Advantage $324.58
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace $324.58
Rate for Payer: Multiplan Commercial $1,514.40
Rate for Payer: NAPHCARE Commercial $486.87
Rate for Payer: Preferred Network Access Commercial $1,741.56
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP $264.01
Rate for Payer: Quartz Beloit One Network $927.57
Rate for Payer: Quartz Commercial $1,230.45
Rate for Payer: Quartz Medicare Advantage $324.58
Rate for Payer: The Alliance Commercial $1,298.32
Rate for Payer: United Healthcare Medicaid $264.01
Rate for Payer: United Healthcare Medicare Advantage $324.58
Rate for Payer: United Healthcare PPO $1,419.75
Rate for Payer: WEA Trust Commercial $1,041.15
Rate for Payer: Wellcare Medicare $324.58
Rate for Payer: WMAP Medicaid $264.01
Rate for Payer: WPS Commercial $1,402.15
Service Code CPT 81235
Hospital Charge Code 5276620
Hospital Revenue Code 300
Min. Negotiated Rate $832.92
Max. Negotiated Rate $1,798.35
Rate for Payer: Aetna Commercial $1,798.35
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,627.98
Rate for Payer: Cash Price $567.90
Rate for Payer: Cash Price $567.90
Rate for Payer: Cigna Commercial $1,798.35
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $946.50
Rate for Payer: Dean Health DHI/DHP/ASO $1,135.80
Rate for Payer: Health EOS Commercial $1,722.63
Rate for Payer: HFN Commercial $1,798.35
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $1,145.77
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $1,145.77
Rate for Payer: Multiplan Commercial $1,514.40
Rate for Payer: Preferred Network Access Commercial $1,798.35
Rate for Payer: Quartz Beloit One Network $832.92
Rate for Payer: Quartz Commercial $1,079.01
Rate for Payer: The Alliance Commercial $946.50
Rate for Payer: WEA Trust Commercial $1,041.15
Rate for Payer: WPS Commercial $1,402.15
Service Code CPT 81235
Hospital Charge Code 5276620
Hospital Revenue Code 300
Min. Negotiated Rate $927.57
Max. Negotiated Rate $1,741.56
Rate for Payer: Aetna Commercial $1,703.70
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,627.98
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $1,003.29
Rate for Payer: Cash Price $567.90
Rate for Payer: Cigna Commercial $1,741.56
Rate for Payer: Health EOS Commercial $1,684.77
Rate for Payer: HFN Commercial $1,741.56
Rate for Payer: Multiplan Commercial $1,514.40
Rate for Payer: NAPHCARE Commercial $1,135.80
Rate for Payer: Preferred Network Access Commercial $1,741.56
Rate for Payer: Quartz Beloit One Network $927.57
Rate for Payer: Quartz Commercial $1,135.80
Rate for Payer: WEA Trust Commercial $1,041.15
Rate for Payer: WPS Commercial $1,402.15
Service Code CPT 15115
Hospital Charge Code 3013635
Hospital Revenue Code 510
Min. Negotiated Rate $138.49
Max. Negotiated Rate $4,085.00
Rate for Payer: Aetna Commercial $4,085.00
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $3,698.00
Rate for Payer: Cash Price $1,290.00
Rate for Payer: Cash Price $1,290.00
Rate for Payer: Cigna Commercial $4,085.00
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid $138.49
Rate for Payer: Dean Health DHI/DHP/ASO $2,580.00
Rate for Payer: Health EOS Commercial $3,913.00
Rate for Payer: HFN Commercial $4,085.00
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $2,294.46
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO $2,294.46
Rate for Payer: Multiplan Commercial $3,440.00
Rate for Payer: Preferred Network Access Commercial $4,085.00
Rate for Payer: Quartz Beloit One Network $1,892.00
Rate for Payer: Quartz Commercial $2,451.00
Rate for Payer: The Alliance Commercial $2,150.00
Rate for Payer: United Healthcare Medicaid $138.49
Rate for Payer: WEA Trust Commercial $2,365.00
Rate for Payer: WPS Commercial $3,185.01
Hospital Charge Code 4519580
Hospital Revenue Code 271
Min. Negotiated Rate $634.55
Max. Negotiated Rate $1,191.40
Rate for Payer: Aetna Commercial $1,165.50
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,113.70
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $686.35
Rate for Payer: Cash Price $388.50
Rate for Payer: Cigna Commercial $1,191.40
Rate for Payer: Health EOS Commercial $1,152.55
Rate for Payer: HFN Commercial $1,191.40
Rate for Payer: Multiplan Commercial $1,036.00
Rate for Payer: NAPHCARE Commercial $777.00
Rate for Payer: Preferred Network Access Commercial $1,191.40
Rate for Payer: Quartz Beloit One Network $634.55
Rate for Payer: Quartz Commercial $777.00
Rate for Payer: WEA Trust Commercial $712.25
Rate for Payer: WPS Commercial $959.21
Hospital Charge Code 4519580
Hospital Revenue Code 271
Min. Negotiated Rate $362.60
Max. Negotiated Rate $5,180.00
Rate for Payer: Aetna Commercial $1,165.50
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper $1,113.70
Rate for Payer: Aetna Managed Medicare $362.60
Rate for Payer: Anthem Blue Access PPO/Blue Traditional $841.75
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus $647.50
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI $621.60
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO $686.35
Rate for Payer: Cash Price $388.50
Rate for Payer: Cigna Commercial $1,191.40
Rate for Payer: Dean Health DHI/DHP/ASO $724.68
Rate for Payer: Health EOS Commercial $1,152.55
Rate for Payer: HFN Commercial $1,191.40
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO $971.25
Rate for Payer: Multiplan Commercial $1,036.00
Rate for Payer: NAPHCARE Commercial $777.00
Rate for Payer: Preferred Network Access Commercial $1,191.40
Rate for Payer: Quartz Beloit One Network $634.55
Rate for Payer: Quartz Commercial $841.75
Rate for Payer: Quartz Medicare Advantage $777.00
Rate for Payer: The Alliance Commercial $5,180.00
Rate for Payer: WEA Trust Commercial $712.25
Rate for Payer: WPS Commercial $959.21